THE EFFECT OF COVID-19 ON MEDICAL EDUCATION

During this COVID-19 pandemic, the global education system is in the process of transformation. Institutions are now taking advantage of online tools in lieu of human interaction inside the classroom.  Many have attended webinars where lecturers and educational institutions utilize various online portals and applications to provide information and instruction. Adapting to these new technologies is especially challenging for teachers and learners.

Various preventive actions to avoid exposure and prevent the spread of the virus have been undertaken in educational institutions. As we come closer to the start of another school year for medical institutions, a number of measures have been pushed to prevent infection. In hospital centers where there are medical students, these include avoiding close contact with sick people, staying home when sick, practicing proper coughing and sneezing etiquette, frequent cleaning and disinfecting of frequently touched objects and surfaces, and practicing proper hand washing.

I have also started to migrate to more online instructional methods recently to reach out to my medical students. However, there are some challenges that I need to face in this so-called “New Normal”.  What are the adjustments that medical faculty and students will have to make in order to deliver medical instruction?  Let us enumerate the issues using the acronym VIRUS.

1.      Variable internet connection.  Internet speeds are not the same in all areas, and the speed subscription may also be different for each household. That is why we must be sensitive to those who may not have fast connections. It is important to be flexible and understanding.

2.      Insufficient clinical exposure. No matter how good an instructional video on how to conduct a physical examination is, nothing beats the examination of a real patient face to face. It is thus a legitimate concern to think that students may acquire the necessary skills to make an accurate physical diagnosis.

3.      Reduced attitudinal assessment. Even before the pandemic, it was difficult to measure attitude. Now, there is the added challenge of making an attitudinal assessment online. Will it simply be based on being on time and showing up? How about the ability to handle stress – can it be done remotely? This is where the creativity and intuition of the instructor will be tested.

4.      Understanding the lesson. It can be harder to understand the professor outside the classroom. There could be more distractions at home. It would be a challenge to keep a student’s focus even for just a few minutes. This may reduce the ability for in-depth understanding.

5.      Study habits. If you are not disciplined enough, it is more difficult to establish a routine at home. Sleeping times can be altered. There is a tendency to turn day into night and vice versa. One may also have reduced physical activity, which leads to weight gain.

All these issues must be addressed if we want our students to continue learning while observing quarantine rules. It would also be a good idea to do research and to evaluate learning outcomes during these times. The quality of education during these times may come in handy for future pandemics when our students will become our health care workers.

Why Do We Need Travel Restrictions?

One of the most difficult realities that we have to face during this Covid-19 pandemic is the fact that we can no longer travel like we used to. According to Mike Osterholm, Director of the Center for Infectious Disease Research and Policy in the United States, the virus is likely to keep spreading for at least another 18 months to two years until 60% to 70% of the population has been infected and herd immunity gradually develops. Herd immunity can only happen when an overwhelming majority of people get infected and get better, or if a vaccine comes along.

Many experts believe that Covid-19 may follow a course similar to what happened during the Spanish flu in 1918.  It is more contagious than the common cold, and a single individual is capable of spreading the virus to at least 2 to 3 people (compared to 1 to 2 people for the common cold).  This results in a potentially exponential rise in cases. And in this day and age, when we can reach the far ends of the globe within a few hours, it does not take long before a virus can spread widely. The worst-case scenario is for the number of infected people to overwhelm the ability of the healthcare system to cope.  This will cause people who would otherwise be in a position to be treated to be neglected, resulting in a high number of deaths. The now-common reminder to “flatten the curve” is intended to prevent this scenario by allowing public health officials to buy time to provide more and better diagnostic and treatment services. And if we allow people to travel like they used to, it could paralyze the health system.

Consider what happened during the 1918 Spanish Flu Pandemic.

Almost all 1918 influenza deaths were due not to influenza itself but to complicating secondary bacterial pneumonias1, necessitating prolonged hospital stays.  Infecting over 1/3 of the world population and killing 50 million people2, it took place at a time when world travel was not as it is today.  Fifty million deaths would be unimaginable today.  The best way to avoid the catastrophe is to control the movement of people.

We also have this tendency to take it easy, then we panic, and then we institute draconian measures to mitigate the disease. When COVID-19 was only prevalent in one country, we became complacent, thinking that it would not reach our shores. It only took a few weeks for us to realize the enormity of the situation, and suddenly we decided to enforce lockdowns.  If we tried to impose travel restrictions early, we may have been more successful in controlling the spread of disease. Unfortunately, some would still want to prioritize economic gains over preventive measures. Could the fact that the most vulnerable population is supposedly those who are retired or retiring becoming a factor? Are we willing to pay the price?

Let us listen to the recommendations of experts. This is not just about the economy. The survival of the human race is on the line. If we do not heed the call to sacrifice, fifty million may turn out to be a measly number.

---

REFERENCES

Parmet, W. E., & Rothstein, M. A. (2018). The 1918 Influenza Pandemic: Lessons Learned and Not-Introduction to the Special Section. American journal of public health, 108(11),1435–1436. https://doi.org/10.2105/AJPH.2018.304695

Short, K. R., Kedzierska, K., & van de Sandt, C. E. (2018). Back to the Future: Lessons Learned From the 1918 Influenza Pandemic. Frontiers in cellular and infection microbiology, 8,343. https://doi.org/10.3389/fcimb.2018.00343

Hope in Times of Crisis

As a Family Physician, it is not unusual to come face to face with a dying patient. Part of the practice entails the ability to provide medical and emotional support to patients and their families during these trying times. Hospice Care is one of the most emotionally draining segments of our training, but it can also be the most fulfilling. The challenge in having a terminally-ill patient is when he or she wants to end it all. Euthanasia is a tempting alternative to a painful death. Ending all suffering in the face of imminent demise seems like a humane idea. But of course, from a legal standpoint in the Philippines, it is not an option.  And so, at times, we engage our patients in an emotional conversation about not thinking about ending one’s life. It can be a nerve-wracking experience for a physician.

During this COVID-19 pandemic, there are moments of despair that can simulate the hopelessness of a chronic illness.  When will this end? Will there be a cure? What will happen if I get infected?

The uncertainties of the times can aggravate an existing tense situation.

Must we give in when there is nothing we can do?

In the history of man, we have known people who gave up. Judas Iscariot is an example. In the depths of his despair, he ended his life. If only he was able to talk to someone, or if only he had emotional support, who knows what could have happened? We tend to be guilty when we make mistakes, when we cause illness, when we become a burden to others. But it must not end with voluntarily ending one’s life.  In the case of Judas, what was the difference with Peter, who denied his Master three times? He said he would do no such thing, but he did. He broke his promise. He could have contemplated to end it all after Christ died.

The important thing is to accept things that we cannot change. Chronic illness, leading to a slow death, is a sad reality that must be accepted. A pandemic cannot be stopped without having everyone infected or having a vaccine available. Never lose hope, for it is hope that elevates us and allows us to slay our personal demons. When all hope is lost, it signals the end. COVID-19 and chronic illness will test our will.

Where can we find strength?

I remember the story of Ignacio de Loyola. He wanted to give up on himself because of what he perceived as the “enormity of his sins”. He thought that he was a murderer, an adulterer, a very worldly man. He thought that what he did was unforgivable. He lost all hope. Until Christ appeared to him and told him: “Do you think your sins have any power over me, if I do not allow it? Just remember, I loved you first”.

The biggest mistake that we can make in this life is to lose hope.

Keep Fighting

Be positive

All of these trying times will enD